[Initial experience of renal autotransplantation in a child with ureteric rupture secondary to abdominal blunt trauma]. / Autotransplantatsiia pochki u rebenka s razryvom mochetochnika posle zakrytoi travmy zhivota.

A 8-year-old child with multiple skeletal injuries after car accident is presented in the article. Extensive right-sided urohematoma with impaired kidney function was diagnosed after 15 days. External drainage of urohematoma, ureteroscopy and examination of the right kidney were consecutively performed within 1.5 months. A complete rupture of the right ureter at the level of pyeloureterostomy was diagnosed. Right kidney autotransplantation with ureteral resection and pyeloureteral anastomosis were performed in 2 months after injury. Duration of surgery was 7.5 hours, cold ischemia - 55 min. Postoperative examination confirmed satisfactory function of the right kidney. This observation is relatively rare and the first in Russia.

The first experience of the use of hydro-surgical technologies in the treatment of children with pulmatic-pleural complications of destructive pneumonia. / Pervyi opyt primeneniia gidrokhirurgicheskikh tekhnologii v lechenii detei s legochno-plevral'nymi oslozhneniiami destruktivnoi pnevmonii.

Drainage and endoscopic methods of sanitation of the pleural cavity do not always allow to achieve effective debridement of pathological contents. AIM: To development and introduction into clinical practice of hydrosurgical technologies for debridement of the pleural cavity. MATERIAL AND METHODS: From 423 children with acute community-acquired pneumonia 88 (20.80%) children destructive pneumonia were diagnosed. Of the 88 patients with destructive pneumonia, 28 patients did not have pleural complications and were excluded from the study. 60 patients were divided into 2 groups depending on the method of surgical treatment. In the first group (n=30), two additional subgroups were formed: IA group (main n=15) - they carried out drainage and washing the pleural cavity with saline; IB group (control n=15) - only drainage of the pleural cavity. The second group (n=30) were also divided into 2 subgroups; Group IIA (main n=15) children operated according to the method of video-assisted thoracoscopic sanitations of the pleural cavity developed by us using hydrosurgical technologies; Group IIB (control n=15) - children are operated on by the method of traditional video-assisted thoracoscopic sanitations of the pleural cavity. A prospective, non-randomized, single-center study was conducted to evaluate the effectiveness of various treatments. The treatment plan was determined on the basis of a combination of anamnesis, clinical and instrumental studies and laboratory parameters. RESULTS: All studied in the comparison groups were homogeneous by sex, weight and height. The results of applying the Kruskal-Wallis test revealed statistically significant differences between the groups for the periods of relief of the intoxication syndrome (p<0.001) and the periods of relief of the pain syndrome (p=0.012) in favor of the main group. Summarizing all analyzing the parameters in the comparison groups allowed us to prove the advantage of the proposed treatment methods over the treatment methods used in the control groups. CONCLUSION: Hydrosurgical methods of treatment demonstrate obvious clinical and economic efficacy, which leads to the rapid reexpantion of the affected lung.

[Diagnostics of Regional Healthcare Management System in Russia Basing on Modeling and Forecasting of Health and Demographic Indicators].

BACKGROUND: Justification of the study direction of public health improving is quite general. But the identification of the most effective indicators of the healthcare system improvement remains unexplored. OBJECTIVE: Our aim was to determine the interaction between the basic demographic indicators of the region (Smolensk region) and efficacy endpoints of the Healthcare management identified in the study. METHODS: The study reviewed the demographic changes of the Smolensk region at present and the forecast for 2015, 2016, 2017. The forecast of demographic and health indicators was based on exponential smoothing models and autoregressive model. RESULTS: The study identified the most appropriate medical and demographic indicators. 1) The ratio of physicians (per 10,000 people in population, the rate maximum was 62 in 2004, in 2015 this figure has fallen to 52, and it is supposed to decrease to 49 by 2017). 2) The overall mortality rate (per 1000 people in population). Reduction of the resident population of the Smolensk region is 8.2 thousand people in annual average. This fact shows a stable depopulation of the region. 3) The average load on the ambulance. It has been found that the increase and decrease of these parameters directly affect the population rate. CONCLUSION: The study revealed a stable downtrend of average resident population number which confirms the long regional depopulation. It is associated in particular with the lack of stimulation of the health and demographic indicators' increase including but not limited to inefficient healthcare management arrangements.

[Laparoscopic herniorrhaphy in children].

It was described the results of endosurgical treatment different technique of 170 children of both sexes aged 4 months to 14 years. Children had inguinal hernia. There were unilateral hernia in 148 patients and bilateral hernia in 22 patients. It was used such interventions as laparoscopic herniotomy with hernial sac extirpation (6 operations), laparoscopic suturing of deep inguinal ring (22 operations), dual-port laparoscopic extraperitoneal herniorrhaphy (46 operations), original single-port laparoscopic extraperitoneal herniorrhaphy (118 operations). The minimum duration of the operation (4.5-7.5 minutes) was observed in the last group. These patients did not need postoperative anesthesia. Relapse was detected in 2 (1.1%) cases. Developed single-port laparoscopic extraperitoneal herniorrhaphy may be alternative in children with inguinal hernia.

[Extraperitoneal ligation herniorraphy by the acute infectious diseases of the abdominal cavity in children].

Surgery on the reason of the "acute abdomen" in children often reveals the persisting vaginal peritoneal defects, which further lead to hernia formation. 23 children (aged 4-15 years) were operated on the acute uncomplicated appendicitis (n=10), acute mesadenitis (n=3), appendicular local and pelvioperitonitis (n=9) and ovary apoplexia (n=1). Inguinal hernia was revealed in all patients during laparoscopy. After videoendoscopic sanation of the abdomen and appendectomy (if it was necessary) the extraperitoneal ligation herniorraphy in author's modification was performed. The were no cases of abdominal complications as well as hernia recurrence among the treated patients.